4-Required Forms-RFP-269-2025-1980.docx

PROPOSAL SUBMISSION FORM

This Proposal is submitted by:

The representative signing above hereby certifies and agrees that the following information is correct:

1. In preparing its Proposal, the Company has considered all proposals submitted from qualified, potential subcontractors and suppliers, and has not engaged in or condoned prohibited discrimination.

2. For purposes of this Section, discrimination means discrimination in the solicitation, selection, or treatment of any subcontractor, vendor or supplier on the basis of race, ethnicity, gender, age or disability or any otherwise unlawful form of discrimination. Without limiting the foregoing, discrimination also includes retaliating against any person or other entity for reporting any incident of discrimination.

3. Without limiting any other provision of the solicitation for proposals on this project, it is understood and agreed that, if this certification is false, such false certification will constitute grounds for the City to reject the Proposal submitted by the Company on this Project and to terminate any contract awarded based on such Proposal.

4. As a condition of contracting with the City, the Company agrees to maintain documentation sufficient to demonstrate that it has not discriminated in its solicitation or selection of subcontractors. The Company further agrees to promptly provide to the City all information and documentation that may be requested by the City from time to time regarding the solicitation and selection of subcontractors. Failure to maintain or failure to provide such information constitutes grounds for the City to reject the Proposal submitted by the Company or terminate any contract awarded on such proposal.

5. As part of its Proposal, the Company shall provide to the City a list of all instances within the past ten years where a complaint was filed or pending against the Company in a legal or administrative proceeding alleging that the Company discriminated against its subcontractors, vendors or suppliers, and a description of the status or resolution of that complaint, including any remedial action taken.

6. The information contained in this Proposal or any part thereof, including its Exhibits, Schedules, and other documents and instruments delivered or to be delivered to the City, is true, accurate, and complete. This Proposal includes all information necessary to ensure that the statements therein do not in whole or in part mislead the City as to any material facts.

7. None of Company’s or its subcontractors’ owners, employees, directors, or contractors will be in violation of the City’s Conflict of Interest Policy for City, Secondary and Other Employment Relationships (HR 13) if a Contract is awarded to the Company.

8. It is understood by the Company that the City reserves the right to reject any and all Proposals, to make awards on all items or on any items according to the best interest of the City, to waive formalities, technicalities, to recover and resolicit this RFP.

9. This Proposal is valid for one hundred and eighty (180) calendar days from the Proposal due date.

I, the undersigned, hereby acknowledge that my company was given the opportunity to provide exceptions to the Sample Contract as provided in the RFP. As such, I have elected to do the following:

___ Include exceptions to the Sample Contract in the following section of my Proposal: _______ ___ Not include any exceptions to the Sample Contract.

I, the undersigned, hereby acknowledge that my company was given the opportunity to indicate any Trade Secret materials or Personally Identifiable Information (“PII”) as detailed in Section 1.6.3. I understand that the City is legally obligated to provide my Proposal documents, excluding any appropriately marked Trade Secret information and PII, upon request by any member of the public. As such, my company has elected as follows:

___ The following section(s) of the of the Proposal are marked as Trade Secret or PII: ________ ___ No portion of the Proposal is marked as Trade Secret or PII.

Representative (signed): ________________________________________________________

ADDENDA RECEIPT CONFIRMATION

Please acknowledge receipt of all addenda by including this form with your Proposal. All addenda will be posted to the City’s Bonfire eProcurement Portal at https://charlottenc.bonfirehub.com/ and the City’s Contract Opportunities Site at http://charlottenc.gov/DoingBusiness/Pages/ContractOpportunities.aspx.

I certify that this proposal complies with the Specifications and conditions issued by the City except as clearly marked in the attached copy.

REFERENCES

Companies shall utilize the format below to provide a minimum of three (3) to five (5) client references. The City’s preference is for references from organizations of similar size or where the Company is performing similar services to those described herein. If such references are not available, individuals or companies that can speak to the Company’s performance are adequate.

REFERENCE:

Name of Client: Main Phone:

Address:

Primary Contact:___________________________ Title:

Contact Phone:____________________ Contact E-mail: __ Service Dates:

Summary & Scope of Project:

Contract Value: $ Number of Client Employees:

REFERENCE:

Name of Client: Main Phone:

Address:

Primary Contact:___________________________ Title:

Contact Phone:____________________ Contact E-mail: __ Service Dates:

Summary & Scope of Project:

Contract Value: $ Number of Client Employees:

Name of Client: Main Phone:

Address:

Primary Contact:___________________________ Title:

Contact Phone:____________________ Contact E-mail: __ Service Dates:

Summary & Scope of Project:

Contract Value: $ Number of Client Employees:

Name of Client: Main Phone:

Address:

Primary Contact:___________________________ Title:

Contact Phone:____________________ Contact E-mail: __ Service Dates:

Summary & Scope of Project:

Contract Value: $ Number of Client Employees:

Name of Client: Main Phone:

Address:

Primary Contact:___________________________ Title:

Contact Phone:____________________ Contact E-mail: __ Service Dates:

Summary & Scope of Project:

BOD FUELING AND PNEUMATIC EQUIPMENT PM AND REPAIR SERVICES

RFP# 269-2025-1946 12

ENVIRONMENTAL PURCHASING RESPONSES

RFP # 269-2025-1980

BOD Fueling and Pneumatic PM and Repair Services Companies shall complete and submit the form below regarding the products or supplies required to perform the Services.

Recycled Content.

Products must contain a certain percentage of recycled content. Please include the amount of recycled content, both pre- and post-consumer, included in your product.

Recyclability.

Please include the types of materials included in your product, and if they are considered recyclable in typical municipal recycling streams.

Biodegradability.

Products must be capable of decomposing under natural conditions. Please state whether each Product offered in your proposal is biodegradable.

Composability.

Products must be capable of composting at a commercial composting facility. Please state whether each product offered in your proposal is compostable.

Energy Consumption.

Please include the total amount of energy consumed for product or service manufacture, use and disposal. Different sources of energy are associated with different environmental impacts.

Energy Efficiency.

Products must meet or exceed the Department of Energy (DOE) and Environmental Protection Agency criteria for use of the ENERGY STAR trademark label; or is in the upper 25% of efficiency for all similar products as designated by the U.S. Department of Energy’s Federal Energy Management Program.

Water Efficiency.

Eligible products must meet or exceed the Environmental Protection Agency’s WaterSense program, or be water-efficient or low-flow fixtures.

Low VOCs.

Products should contain low or no volatile organic compounds (VOCs). Please indicate any VOC content in each applicable product offered in your proposal.

Reduced Packaging.

Please include any efforts made to reduce the packaging of the products included in this proposal.

Pollution Prevention.

Please state your company’s policy on source reduction. The Pollution Prevention Act defines source reduction to mean any practice that: (1) Reduces the amount of any hazardous substance, pollutant or contaminant entering any waste stream or otherwise released into the environment (including fugitive emissions) prior to recycling, treatment or disposal, and (2) Reduces the hazards to public health and the environment associated with the release of such substances, pollutants or contaminants. The term includes: equipment or technology modifications, process or procedure modifications, reformulation or redesign of products, substitution of raw materials, and improvements in housekeeping, maintenance, training or inventory control.

Life Cycle Management.

Please state how many times your product may be reused. (Since reusable products generally require more upfront costs than disposable products, they are often subjected to a cost/benefit analysis in order to determine the life cycle cost).

End of Life Management.

Will the manufacturer or designee accept the product back at the end-of-life? (who pays for the transportation of the product may be situation-specific).

COMPANY’S BACKGROUND RESPONSE

Companies shall complete and submit the form below as part of their response to this RFP. Additional pages may be attached as needed to present the information requested.

1. Company’s legal name.

2. Company Location (indicate corporate headquarters and location that will be providing the Services).

3. How many years has your company been in business? How long has your company been providing the Services as described in Section 3?

4. How many public sector (cities or counties) clients does your company have? How many are using the Services? Identify by name some of the clients similar to City (e.g., similar in size, complexity, location, type of organization).

5. List any projects or services where your company was terminated or removed. Please disclose the entity that terminated and explain the reason for the termination.

6. List any litigation that your company has been involved with during the past two (2) years for Services similar to those in this RFP.

7. Provide an overview and history of your company.

8. Describe the key individuals along with their qualifications, professional certifications and experience that would comprise your company’s team for providing the Services.

9. Provide information regarding the level of staffing at your organization’s facilities that will be providing the Services, as well as the level of staffing at subcontractors’ facilities, if known or applicable.

10. What steps will your organization take to ensure that the transition of Services runs smoothly?

11. Describe the communications scheme that your organization will use to keep the City informed about the Services.

12. Describe the risks associated with this Contract. What contingencies have been built in to mitigate those risks?

Required Forms

Exceptions Form The undersigned Proposer agrees to provide all Products and Services requested in the RFP for the price(s) set forth in the Pricing Sheet, all in strict conformity with the terms, conditions and specifications set forth in the RFP and the Sample Contract (including any addenda or amendments), subject only to the exceptions stated in the chart below. Exceptions representing material changes to Proposal terms are grounds for rejection of the Proposal.

RFP/Contract Section Number RFP/Contract Section Title Exception and Proposed Change to RFP and/or Sample Contract

Date:

Company:

By:

Signature:

Print name and title of signatory

Required Forms

[Vendor Name]

CONTRACT NAME 1

LIST OF SUBCONTRACTORS/SUPPLIERS - FORM A

Project DBE and non-DBE Subcontractor/Supplier Utilization Commitment Federal Disadvantaged Business Opportunity Program. Note: This MUST be submitted with your Bid. Make copies as needed.

If you fail to meet the DBE Goal for this Project, you MUST complete FORM C and attach documentation of your Good Faith Efforts with your Bid package.

Bidders Name:

Project Name:

Below list ALL SUBCONTRACTORS AND SUPPLIERS (including DBEs) that you intend to use on this Contract. Continue listing on the supplemental form.

Annual Gross Receipts: |_| Less than $500,000 |_| $500,000 - $1M |_| $1-2M |_| $2-5M |_| Over $5M

Annual Gross Receipts: |_| Less than $500,000

Annual Gross Receipts: |_| Less than $500,000

|_| I acknowledge that I have confirmed the certification of each DBE listed above on https://partner.ncdot.gov/VendorDirectory/default.html

Please read the following “Certification” statement before signing. “The undersigned certifies that he/she has read, understands, and agrees to be bound by the DBE Program Requirements, including these accompanying FORM(s) A, and the other terms and conditions in the Notice to Bidders. The undersigned further certifies that he/she is legally authorized by the Bidder to make the statements and representations and that said statements and representations are true and correct to the best of his/her knowledge and belief. It is the intent by the undersigned to enter into formal agreement(s) with subcontractors/suppliers named on this Form conditioned upon execution of a contract with the City. All DBE subcontractors/suppliers must provide proof of their DBE status or receive confirmation of their status from the City’s Civil Rights Officer prior to contract award. The undersigned understands and agrees that if any of the statements and representations are made by the Bidder knowing them to be false, or if there is a failure of the successful Bidder (i.e., the Contractor) to implement any of the stated agreements, intentions, objectives, goals, commitments and substitutions set forth herein without prior approval by the Civil Rights Officer or a designee, then in any of such events the Contractor's act or failure to act, as the case may be, shall constitute a material breach of the contract, entitling the City to terminate the contract for default. The right to so terminate shall be in addition to, and not in lieu of, any other rights and remedies the City may have for other defaults under the contract, or otherwise. Additionally, the Contractor will be subject to the loss of any future contract awards”.

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